Use of dexemedetomidine–fentanyl versus midazolam–fentanyl for sedation during awake fiberoptic intubation: a randomized double-blind controlled study

Abstract

Background and objective Sedation for awake fiberoptic intubation is considered a great challenge for anesthetist to maintain patient’s airway patent during sedation. The aim of this study is to compare the effect of dexmedetomidine–fentanyl versus midazolam–fentanyl combination on patient’s ventilation during sedation for awake fiberoptic intubation.Patients and methods A total of 60 patients, 20–60 years old, with American Society of Anaesthesiologists classification I and II, were enrolled in the study to be scheduled for awake nasal fiberoptic intubation for cervical spine surgery. Patients were divided into two groups. Group 1 received fentanyl 1 μg/kg, intravenously+midazolam, intravenously, 0.05 mg/kg followed by saline infusion (placebo) with additional doses of midazolam (0.05 mg/kg) to achieve a Ramsay Sedation Scale score of greater than or equal to 2. Group 2 received fentanyl 1 μg/kg, intravenously+dexmedetomidine, intravenously, 1 μg/kg infusion over 10 min, and then the infusion of dexmedetomidine 0.1 μg/kg/h and titrated to 0.7 μg/kg/h to achieve Ramsay Sedation Scale greater than or equal to 2.Measurements Vital signs (heart rate, systolic blood pressure, and oxygen saturation) as well as respiratory rate were recorded. Arterial blood gases sampling was done before and after the intubation. The Observer’s Assessment of Alertness/Sedation Scale was used to assess the level of sedation. The visual analog scale used to assess patients’ recall and discomfort, and finally, time to intubation in both groups was also recorded.Results There was significant decrease in heart rate, no difference in systolic blood pressure, and significant increases in SpO2 and PaO2, with preservation of patient’s ventilation in dexmedetomidine group. No difference was noted in visual analog scale score or time to intubation between both the groups.Conclusion Dexmedetomidine provided better intubating conditions, better patient tolerance, higher patient satisfaction, and good hemodynamic responses compared with midazolam, with preservation of arousability in addition to better ventilation properties.